Struggling with vision loss

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Screenshot of OpenEd website with simulated vision loss (includes shadowing, blurring and floaters)Within the last month the vision in my right eye has significantly diminished. This personal blog post details what the impact has been on my daily life and how recent web accessibility work has helped me cope a little better.

Subtitling legacy content

Since 2014 we’ve always made a concerted effort within my team to publish subtitles for our video content. We even ran a series of workshops demonstrating how to take advantage of YouTube’s built-in tools to generate subtitles quickly and accurately. These instructions are still available as an open-licenced PDF handbook and PowerPoint presentation:

YouTube subtitling tutorial (last updated 2015)

However, some videos predate this decision and we’re now in the process of adding subtitles to a series of popular healthcare videos as part of a major website relaunch:

STARs (Stroke Training and Awareness Resources) website

Four weeks ago, I was adding subtitles to a series of short clips, originally published in 2008, that offer guidance on how to carry out a visual field assessment.

Video demonstrating a visual field test

Retinal detachment

Less than a week later I was in A&E having the very same test performed on me after suddenly experiencing flashing lights and impaired vision. Within 24 hours I’d been diagnosed with a retinal detachment in my right eye. There are a number of reasons why people experience this condition, mine is directly related to my type 1 diabetes.

A detached retina is when the thin layer at the back of your eye (retina) becomes loose. It needs to be treated quickly to stop it permanently affecting your sight.

NHSHealth A to Z ‘Detached retina’

Impact on my work

Since that initial diagnosis I’d estimate my right eye has deteriorated a little further and I now have 50-60% vision remaining. I’m regularly experiencing mild eye fatigue, regular flashes and pretty constant light sensitivity. All of these combined make me quite tired and anxious. My work rate has slowed down and I’ve had to communicate my current predicament to my team and key clients in order to explain slower responses rates, but also manage expectations for the near future.

Almost everyone I’ve shared my news with has been thoughtful and supportive. I do believe I’m fortune to have such kind team members, colleagues, friends and family. It’s too much to handle on my own and I’m trying to lean on other people more than I have done ever before.

Vision loss simulation

To help communicate my current experiences I’ve created a simple H5P interactive simulating the vision loss in my right eye when looking at a typical website on a 13-inch laptop. Drag the red slider horizontally to see a before and after comparison.


Some of the key features I’ve attempted to depict include:

  • Large dark shadow and blurring on the left-hand side
  • Minor white/yellow flaring in the middle
  • Small dark dots and squiggly lines (floaters) all-over

Finding some positives

Introduction to web accessibility MOOC

Back in mid-April I enrolled in a new online course as part of my continuing professional development. W3C is running a four week ‘Introduction to web accessibility’ MOOC on the edX platform for free. It’s suitable for both a technical and non-technical audience. The good news it’s recently been extended to September 2020.

Following the changes to my own eyesight this course has taken on a whole new meaning. There are some amazing video interviews that effectively demonstrate a wide variety of different user’s needs. It is still occasionally a little upsetting to watch some of these videos, but I’m slowly progressing through the course and have found a new motivation to keep improving the accessibility of our web content.

Introduction to web accessibility MOOC

Accessibility auditing our websites

Over the last eight months I’ve been performing a series of accessibility audits across our extensive web portfolio. This has resulted in a number of improvements to the majority of our websites, typical changes include:

  • Improved colour contrast ratios
  • Appropriate and consistent use of headers (H1, H2, H3…)
  • Adding missing meta descriptions (e.g. alt attribute for images)
  • Repairing broken links and reducing the number of links in long lists or navigation menus
  • Adding missing page titles and optimising the length of others

All of these amendments are in preparation for publishing up-to-date, accurate and detailed website accessibility statements that we are now required to have on all our sites.

Similar to the MOOC I’m enrolled in, these recent accessibility audits have been quite challenging to perform. Not just from an emotional perspective, but practically speaking too. The audit tools used to inspect websites require multiple windows open and sizeable quantities of HTML and CSS to review and tweak. This can be tiring at the best of times, but even more so now. However the pay-off is always there, and seeing the number of WAVE (Web Accessibility Evaluation Tool) errors and alerts reduce for each site is extremely satisfying.

WAVE Web Accessibility Evaluation Tool

Waiting for a phone call 

Three weeks have passed now and still no date for when surgical procedures will resume at my eye hospital. However, I’m acutely aware of media coverage reporting dates for garden centres reopening and football games resuming. I suspect most people feel confident we’re now transitioning out of lockdown, my personal belief is the situation is far more fragile. 

My consultant has explained that normally they would have carried out this surgery without delay, but “their hands are tied”. However, I try to stay positive and hope that the next phone call is news of an upcoming appointment.

Playing my part

I try not to read to too much literature about my condition and certainly only read trusted sources (NHS, Diabetes UK and RNIB). But the longer I wait for surgery my chances of successful sight restoration are likely to diminish. Even with surgery there are absolutely no guarantees.

Unfortunately, for some people, surgery may be successful at reattaching the retina, but it may not bring back detailed central vision or areas of peripheral vision. This can happen in any circumstance, but the risk is higher the longer the retina has been detached without any surgery.

RNIBInformation on retinal detachment

It’s a lot take on board, but I have no option other than to keep looking after myself the best I can. Good diabetic control asks for blood glucose levels within your target range and low variability. Type 1 diabetes is a relentless and demanding disability at the best of times and lockdown has introduced some new challenges. But my diabetic consultant is pleased with my results (past and present) and has asked me to keep doing what I’m doing.

Still struggling

Perhaps a little different from my other articles, this blog post was very much written as a reflective exercise to help me process an ongoing traumatic experience. I was initially hesitant about sharing it, but in the last two months I think we’re all more honest about our feelings and having the confidence to say out loud that sometimes we are struggling to cope.

Having lived with type 1 diabetes for 30 years it’s important for me to talk openly about invisible disabilities. This current vision loss I’m experiencing is another hidden disability and unless I say it out loud it potentially goes unnoticed. People often start their emails with the rhetorical question “I hope you’re well?”, but I think we all deserve an honest answer.

Further reading

Trusted healthcare resources

NHS guidance on vision loss

RNIB information on retinal detachment

Recommended University blog posts on accessibility

Jonathan Trout – ‘Taking responsibility for Web Accessibility’

Andrew Millington – ‘First Steps into Accessibility Auditing’

Copyright and licence

The text, images and interactives published within this post are all intended to be shared, reused and remixed. In order to encourage this I’ve applied a Creative Commons open licence to my own content where the only requirement is to include the following attribution.

Copyright © Stewart Lamb Cromar, The University of Edinburgh 2020 CC BY.

This work is licensed under a Creative Commons Attribution 4.0 International License.

The only exception is the STARS ‘visual field test’ video which has the following copyright, licence and attribution:

Copyright © Chest Heart & Stroke Scotland and The University of Edinburgh 2020 CC BY-NC-SA.

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

One comment

  1. I’ve just stumbled across your blog post. So sorry you’re having to cope with this and thank you for the reminder about why accessibility is so important. Thinking of you and hoping that you can get treatment soon.

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